Every year, about 140,000 Americans die from stroke. Carotid disease, blockage of the carotid arteries that deliver oxygenated blood to the brain, remains one of the leading causes of stroke.

For many years, surgeons utilized carotid endarterectomy and carotid stenting as main treatment options for patients at risk of stroke. However, these procedures pose a high risk of heart attack and stroke during the surgery, respectively.

An innovative new technique mitigates these risks. This technique is called TCAR or TransCarotid Artery Revascularization.

Vascular surgeon, Dr. Afshin Andrew Skibba, of Premier Surgical Associates recently performed the first TCAR procedure at Fort Sanders Regional Medical Center in Knoxville, TN. It was also the first TCAR procedure for the Covenant Health system.

What is TCAR?

TCAR stands for TransCarotid Artery Revascularization. It’s an innovative technique introduced by the company Silk Road Medical. It is a minimally-invasive procedure, uses a special transcarotid neuro-protection system to reduce the risk of stroke during stent insertion. Dr. Skibba shares that the stroke risk from the TCAR procedure is only about 1.4%, which is dramatically lower than what current procedures offer.

What happens during the TCAR procedure?

The surgeon creates an incision just above the collar bone to expose the carotid artery. A soft, special sheath is placed directly into the carotid artery and connected to a neuro-protection system, which reverses the blood flow. This protects the brain from the fragments that may possibly get loose during the procedure.

The blood is filtered and returned to a second sheath, which is placed in the patient’s femoral vein.


While the blood flow is reversed, a transcarotid stent is inserted to open and clear the blockage. Once this has been accomplished, the flow reversal is turned off and the normal blood flow to the brain is restored.

Dr. Skibba says one of the advantages of the procedure is the quick recovery. “After the procedure, they are back to their regular lives within the next several days.”

Are you an ideal candidate?

Not everyone is a candidate for the TCAR procedure. “As it stands right now, in order to qualify to have a TCAR performed, the patient has to meet certain high-risk criteria,” explains Dr. Skibba.  “Thankfully, given the population of people who require carotid revascularization, the majority meet these criteria and are eligible to have a TCAR.”

For more information about Vascular procedures performed by the physicians of Premier Surgical in Knoxville, visit our Vascular Surgery page. https://www.premiersurgical.com/premier-surgical-services/vascular-surgery/